2018 Update on pelvic floor dysfunction

The debate around universal cystoscopy following benign gynecologic surgery is ongoing.

The studies discussed in this Update demonstrate that cystoscopy following hysterectomy for benign indications:

• is superior to visualizing ureteral peristalsis
• increases detection of urinary tract injuries, and
• decreases delayed urologic injuries.

Although these articles emphasize the importance of detecting urologic injury, the picture would not be complete without mention of cost-effectiveness. Only one study, from 2001, has evaluated the cost-effectiveness of universal cystoscopy.¹ Those authors concluded that universal cystoscopy is cost-effective only when the rate of urologic injury is 1.5% to 2%, but this conclusion, admittedly, was limited by the lack of data on medicolegal settlements, outpatient expenses, and nonmedical-related economic loss from decreased productivity. Given the extensive changes that have occurred in medical practice over the last 17 years and the emphasis on quality metrics and safety, an updated analysis would be needed to make definitive conclusions about cost-effectiveness.

While this Update cannot settle the ongoing debate of universal cystoscopy in gynecology, it is important to remember that the American College of Obstetricians and Gynecologists and the American Urogynecologic Society recommend cystoscopy following all surgeries for pelvic organ prolapse and stress urinary incontinence.²

References

1. Visco AG, Taber KH, Weidner AD, Barber MD, Myers ER. Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol. 2001;97(5 pt 1):685–692.
2. ACOG Committee on Practice Bulletins–Gynecology and the American Urogynecologic Society. Urinary incontinence in women. Female Pelvic Med Reconstr Surg. 2015;21(6):304–314.